Plea for timely truth about football's link to brain disease

Ann McKee, MD / AP

Photos provided by Boston University show sections from a normal brain, top, and from the brain of former University of Texas football player Greg Ploetz, bottom, in stage IV of chronic traumatic encephalopathy (CTE).

Photos provided by Boston University show sections from a normal brain, top, and from the brain of former University of Texas football player Greg Ploetz, bottom, in stage IV of chronic traumatic encephalopathy (CTE). (Ann McKee, MD / AP)

The “Concussion” movie depicted a David vs. Goliath theme where one pathologist fought the NFL. As part of the film, the doctor is credited with discovering and naming CTE; however, the reality is this brain disease was first discovered in the 1920’s well before the subject of the “biography” was born.

Yet last week, at an American Academy of Neurology concussion meeting, researchers and clinicians contradicted the media and public narrative by stating “it is unlikely that concussion is a risk for neurodegenerative disease.” They continue by saying the association between trauma and CTE is unclear, as well as that the association between CTE and symptoms are unknown. The research also pointed out ex-NFL players live longer, and suicide is less common, than the general public.

There is much more we don’t know about concussions than what we do know.

Consider that the long-standing recommendation after a concussion was to rest in a quiet dark room. Now there is evidence that controlled brain stimulus is more conducive to recovery.

Currently in the media, virtually all concussions are depicted as the same. And that simply can’t be the case. Seeing “stars” momentarily after a hit can’t be the same injury as becoming unconscious and losing memory.

One day we hope to have precise classifications for the types of head injury. For example, the outcome of a “grade 2b occipital lobe concussion” or a “grade 3c temporal lobe concussion” might have different treatment and prognosis. It is hard to find a cure when you don’t know the exact disease.

The truth is our knowledge of head injury today is like that of knee injuries in the pre-MRI and arthroscopy era. Everything was a knee sprain and we didn’t differentiate between ACL, PCL, MCL, LCL, or medial versus lateral meniscus tears. In the 1970s, doctors routinely removed all meniscus, thinking of them as unnecessary. Now we know that is wrong and we do everything to preserve meniscus.

We don’t know if the “you got jacked” highlight hit is the culprit for CTE or if multiple sub-concussive blows are more dangerous. We don’t know if there is a genetic predisposition. We don’t even know how to objectively diagnose a concussion other than subjective patient testing.

Certainly, 110 out of 111 former NFL players with pathologic signs of concussion is concerning – even if it is a biased sample and having Tau protein doesn’t equate to symptoms. Certainly, we need age-matched controls and better science, but we shouldn’t ignore these early findings either.

In one recent study, 55% of the population with a history of head trauma and substance abuse had CTE signs at autopsy versus 20% in those who did not have that history.

Competing scientists should not be fighting to sign up brains for when someone passes. We should be studying these people while they are alive and trying to offer help and support.

It should be made clear this is the view of an orthopedic surgeon and sports medicine specialist who does not routinely evaluate, treat or study head injury.

However as a former NFL head team physician (for 17 years), I am acutely aware of the controversies that surround the issue. I have been personally affected by CTE and suicide. Since 2010, four former professional athletes (only two were NFL) that I personally knew have committed suicide, and a few were very close friends. I am passionate about the issue and finding a solution.

I am a medical professional and football fan, but I have no reason to defend the NFLor scientists that have delivered a confusing picture.

In any case, the problem is bigger than football and involves everyday life, the military as well as many other sports where there is concussion risk.

But we must stop the posturing and get to the truth.

That truth is probably going to end up somewhere in the middle – between where the media has it and what conservative scientists are willing to conclude today.

At this point, I am not sure if I would let my son play football. I know my wife would not. I do know I hope he likes and chooses a non-collision sport, so I won’t have to decide. Right now, there is just not enough information. Fortunately, my son is just four-years-old, so I have time. I hope science can advance to reveal the truth by the time my son might be ready for football.